Socks: Getting in shape with new technologies

Socks are often an afterthought for patients with diabetes, but they shouldn’t be. Advances in materials science and new twists on old favorites mean that modern socks conform to feet without the bunching, chafing, slipping, and irritation of the past. Some even promote healing.

Socks have come a long way since the days of the long white tube with the colored bands around the top. A visit to any sporting goods store will offer a rock climbing wall’s worth of “performance socks,” tricked out with high-tech properties such as moisture wicking, temperature control, and arch support.

No doubt that these sock manufacturers have taken more than a few cues from diabetic socks, which have always combined fibers to maximize support, cushioning, and comfort. But do diabetic socks offer advantages to patients beyond these performance socks? Yes and no, according to the experts. Proper fit and sizing play a big part in ensuring that diabetic socks do their job.

Materials

One hundred percent cotton or wool socks have been criticized for not maintaining the sock’s shape on the foot, which can be problematic for diabetic patients on two fronts. The increased friction between the skin and the fibers can lead to ulcerations. In addition, 100% cotton or wool socks may start out quite tight, possibly reducing circulation in patients who already have compromised blood flow. As the socks are worn over time, the fibers loosen, resulting in a sock that slides between the foot and the shoe, again leaving diabetic patients vulnerable to shear, blisters, and potential ulcerations.

On the other hand, purely synthetic socks may not allow sweat to evaporate properly; sweaty feet can lead to fungal infections, which in and of itself is more complicated in a patient with diabetes than an otherwise healthy subject and can also be another gateway to ulceration. Synthetics blended with natural fibers would seem to be the best bet, offering support and—most importantly—breathing room, according to Marybeth Crane, MS, DPM, FACFAS, CWS, managing partner of Foot and Ankle Associates of North Texas in Grapevine.

“I’m not one that really likes totally cotton socks,” she said. “I find that socks with a little bit of Lycra in them are better. They also offer some compression to address swelling.”

Crane also advocates seamless socks because seams, constantly rubbing against the skin, may cause blisters, calluses, or ulcerations. For a patient with neuropathy, a skin irritation caused by the seam will not be felt immediately, increasing the risk of calluses and other pre-ulcerative conditions.

Moisture wicking can be achieved with a variety of materials: Wool, synthetics, cotton, silk, and renewable materials. Each has its pros and cons.

The biggest advantage of wool, and merino wool in particular, is that it is thermostatic so that feet stay comfortable in a range of temperatures. Wool also can absorb 30% of its own weight in water so feet are more likely to stay dry. Cushioning is another benefit, because diabetic patients have an increased risk for pressure ulcers and because focused areas of high plantar pressure are most likely to become sites of ulceration. On the downside, wool dries out slowly, and wool socks generally carry a higher price-tag than other materials. Both factors could prove problematic for a diabetic patient who cannot afford multiple pairs of socks.

Synthetics, such as nylon and Lycra spandex, help socks retain their shape. Some synthetics may provide arch support, which can help lateralize plantar pressures and provide a bit of extra stability for diabetic patients who have problems with balance. Socks with polypropylene, polyester, or acrylic fibers will offer moisture wicking. Synthetic socks are durable but may be unsuitable for warmer climates. In addition, the socks’ insulation properties may be reduced if the socks get too wet.

Silk is a natural insulator that is often blended with wool for extra softness. The lightweight material offers reliable wicking and a smooth texture; however, it is less durable than other materials. This is important not only with regard to the cost and inconvenience of replacing socks, but also because areas of wear in a sock’s fabric fail to protect the diabetic foot and leave skin vulnerable. In addition, the very “silkiness” of a silk-based material could cause the foot to slip within the shoe, leading to abnormal skin shear and friction-induced skin issues.

A full cotton sock is not advisable for the diabetic foot. The material is easily saturated with sweat and dries slowly, both of which leave the foot vulnerable to blisters. Cotton is less expensive than other materials and, when blended in small quantities with synthetics, it can offer softness.

Eco-friendly materials, such as bamboo, corn-based polylactic acid (PLA), hemp, and charcoal, offer moisture wicking and odor control properties. Combining these materials with synthetic fabrics ups their durability.

Finally, socks made of fabrics embedded with copper, silver, or charcoal fibers offer protection against bacteria. Patients with diabetes are less resistant than healthy individuals to infection, which can lead to complications such as cellulitis (diffuse inflammation of the connective tissue) or osteomyelitis (bone infection, which almost always occurs in the presence of an ulcer). However, a sock billed as resisting bacterial growth does not automatically reduce the chance of infections on the surface of the foot, nor will this type of fabric necessarily protect an open wound from becoming infected. Visual inspection of the feet, along with daily washing, is still needed to avoid infection.

Socks come in sizes

While it’s obvious to patients with diabetes that their shoes come in sizes, the same cannot always be said for socks.

“A lot of patients don’t realize that their socks need to be the correct size,” Crane said. “If the sock is too tight, it can cause ingrown toenails, it can cause problem with compression in between the toes, it can cause ulceration between the toes.”

Crane said she advices her patients with diabetes to “size up” when it comes to socks.

“For instance, I wear a size 6-6.5 (in shoes) and most size small socks go to 6. I’ll go to a medium sock instead of a small because they will shrink once they are washed,” she said.

Socks that are too tight can reduce flow, which is particularly problematic in patients whose diabetes is complicated by vascular disorders. Poor blood flow impairs healing of existing ulcers and other wounds; it can exacerbate loss of sensation in neuropathic patients, increasing the risk of neuropathic ulcers; and it can also increase the risk of ischemic ulcers, which are even more difficult to heal. However, socks that are too big can wrinkle or bunch inside the shoe, putting excess pressure on the feet. For patients with neuropathy, a bunched sock can easily lead to blisters or ulcerations.

But as with shoes, neuropathic patients often need a sock to feel snug against their leg. A sock with binding elastic at the top may feel right to these patients, but can negatively impact blood flow.

If possible, socks and shoes should be fit simultaneously, Crane added.

“One of my pet peeves is that the socks and shoes are not fit at the same time,” she said. “I have a patient who has a beautiful pair of diabetic shoes, but she wears them with pantyhose that she buys at the drug store. The hose have a seam in them and that causes an ulceration on the tip of her toe.”

Another argument for fitting shoes and socks simultaneously is that once a sock size has been determined, the shoe size may change. For instance, a neuropathic patient who is prescribed a therapeutic sock with silicone padding to reduce plantar pressure may have to go with a shoe that is a half-size larger or convert to extra-depth shoes.

OTS socks

Crane pointed out that socks are not covered under the Therapeutic Shoe Bill (see HEADLINE, PAGE XX) so they are an out-of-pocket expense for the patient.

“Good socks are expensive,” she said. “You can’t buy a good pair of socks for $4. You are looking at as much as $20.”

As a result, off-the-shelf (OTS) socks are not always out of the question.

“In terms of the OTS, performance socks, I like the ones that have a bit of Lycra and a bit of either DryWeave or CoolMax to wick the sweat away from the foot. That’s necessary whether the person is a diabetic or not,” she said.

But these performance socks don’t necessarily offer the kind of support that a diabetic foot requires, pointed out Roy H. Lidtke DPM, CPed, FACFAOM, associate professor of podiatric medicine and surgery at Des Moines University and director of the Center for Clinical Biomechanics at

St. Luke’s Hospital, Cedar Rapids, IA. Socks made especially for patients with diabetes provide that support, along with added benefits.

“They offer extra padding and compression that can produce a form of neuromuscular feedback,” Lidtke said. “An example would be when you wear a pair of padded socks with areas of elastic compression and you feel a tightness around your arch. This provides greater proprioceptive feedback on the position and neuromuscular control of the foot.”

Diabetes is often complicated by a loss of postural control, which research suggests is a product of more than just the loss of sensation that accompanies neuropathy. Any intervention that can improve proprioception could potentially also help to improve postural control and, in turn, reduce patients’ risk of falling.

Higher the Heels and Greater the Dangers

X-rays show how high heels stretch the foot’s arch. Doctors say long-term use has painful consequences.

Tamiko Woolfalk rattled off her list of high heels, beaming as if they’re achievement awards.

Boots, pumps, booties, the red ones ... and the gray ones that she still needs to find a shirt to match.In all, she counted 30 pairs in her closet, with heels ranging from 2 to 5 inches high.

“Do they hurt? Absolutely,” said the Far West Side resident. “The worst is the burn on the balls of the feet. But it’s worth it.”

Stiletto-enthusiasts such as Woolfalk say foot pain is the price you pay for the confidence that comes with wearing high heels.

Physicians, however, say the price is steeper than that. More and more, podiatrists and orthopedic surgeons are educating women about the long-term consequences of wearing the wrong shoes, particularly high heels. Aside from foot, lower-back, neck and shoulder pain, they say, high heels also can lead to foot deformities. And recently they have been linked to arthritis.

A recent poll by the Society of Chiropodists and Podiatrists found that 25 percent of women who wear high heels every day are more likely to get arthritis. Other studies from various medical journals this year show that walking on high heels increases bone-on-bone movement in knee and hip joints, increasing the risk of osteoarthritis.

A study released in March by Finnish researchers concluded that women who wear high heels for 40 hours a week over two years walk differently from women who wear them 10 hours a week. Those habitual high-heel wearers take shorter, more-forceful strides and walk less efficiently, the study found.

Many women who wear heels every day develop tight Achilles tendons, which can cause back pain and make it more difficult for them to walk barefoot or in flat shoes. Other conditions include bunions, hammertoes, calluses and Haglund’s deformity, also called a “pump bump.”

A recent survey by the American Podiatric Medical Association found that 53 percent of women experience foot pain.

“It’s hard to think, in general, that people are so accepting of pain that they don’t question it. Foot pain is not normal,” said Dr. Lori DeBlasi, a Columbus podiatrist who works at Specialized Orthopaedics & Sports Medicine.

DeBlasi said she cringes when she walks through department stores and sees all of the high heels on display.

Woolfalk, 34, a patient-care coordinator in DeBlasi’s office, said that, despite seeing the many foot conditions at work, she maintains a strong fondness for her shoes.

They’ve taken her to nightclubs, where they’ve carried her feet across dance floors for hours at a time. For years, she has witnessed the attention garnered by elongated legs and slim calves.

“You can’t go to the club with sneakers — it’s about the height of the shoe, the sexiness of the calf. It’s a good time and a nice picture,” she said. “Nothing can change my mind about these shoes. ”In some cases, the loyalty to foot fashion goes to extremes. Some women go as far as amputating toes to fit into shoes. It’s called toe tucking.

There have been reported cases in New York City when women pay as much as $2,000 to have part of or all of a pinkie toe removed so they can better fit into pointy shoes.

“These are extreme cases, but it shows you this is the same as the Chinese foot-binding,” said Dr. Judith Smith, an surgeon in Springfield, Mo. “It is a fashion statement and a status symbol.”

Smith, a member of the board of directors of the American Orthopaedic Foot and Ankle Society’s outreach and education fund, performed a survey in the 1990s that found that 88 percent of women wore shoes that were too narrow, and 76 percent had some sort of foot deformity. Over a 15-year period, 87 percent of forefoot procedures were in women, according to her report.

Smith said she has had patients who were told their surgeries would be ineffective if they continued wearing high heels, yet they still did.

“There’s almost a disconnect there. They just can’t imagine life without these shoes.”

Woolfalk said she has worn her beloved heels less over the past few years but doesn’t plan to cut them out of her life. She said she hasn’t had any lasting consequences from her years of foot pain.

Predicting who will develop foot problems is like trying to predict which cigarette smoker might get cancer, Smith said. “Our job is to educate them on the problems that can arise.”

Some tips from medical professionals:

• If you must wear heels, stick to a wedge rather than a stiletto to maximize stability and keep your feet from rocking side to side.

• Try to keep heels to 1 to 2 inches high, and don’t wear them for more than a few hours at a time.

• Buy shoes at the end of the day, when feet are at their largest.

• Leave enough room in the toe of the shoe to slip in a finger.

• Buy shoes with good arch and heel support. Ballet flats and flip-flops can be just as harmful as high heels if they are too flexible and don’t support your feet.

Americans Underestimate Weight Gain

Even though the average adult weight rose in 2008-2009, most surveyed thought they'd dropped pounds

If you've ever stepped on the scales and been shocked at the number you see, then you're not alone: a large new study finds that Americans routinely underestimate the amount of extra pounds they pack on.

The finding could have real implications for the U.S. obesity epidemic, the researchers said.

The study's lead author, Catherine Wetmore, said in an institute news release. "If people aren't in touch with their weight and changes in their weight over time, they might not be motivated to lose weight." The study was based on national survey data involving 775,000 American adults from 2008 and 2009.

Wetmore's team notes that many adults thought they had actually lost weight when they hadn't. That's important to note, Wetmore said, because data that underestimate the growing obesity epidemic could have serious public health consequences.

For example, she said, "If we had relied on the reported data about weight change between 2008 and 2009, we would have undercounted approximately 4.4 million obese adults in the U.S."

Karen Congro, nutritionist and director of the Wellness for Life Program at the Brooklyn Hospital Center, New York City said, "I see this in the clinic every single day; people think they are a certain weight, and they are totally wrong. There is a disconnect between perception and reality when it comes to weight." "When it comes to weight, there is a lot of magical thinking going on."

In the surveys used in the study, participants were asked about their weight at the time of the survey, as well as how much they weighed one year ago.

The researchers report that, on average, American adults gained weight in 2008. However, even though the average reported weights rose between the two surveys, Americans polled typically thought they had lost weight in the past year.

Since the prevalence of obesity actually increased slightly between 2008 and 2009 (from 26 to 26.5 percent) and the average weight increased by about 1 pound, the researchers concluded that those surveyed were unclear about the change in their weight over the course of the year.

"We all know on some level that people can be dishonest about their weight," IHME professor Ali Mokdad said in the news release. "But now we know that they can be misreporting annual changes in their weight, to the extent of more than 2 pounds per year among adults over the age of 50, or more than 4 pounds per year among those with diabetes. On average, American adults were off by about a pound, which, over time, can really add up and have a significant health impact."

The researchers noted that women seemed more aware of fluctuations in their weight than men. Younger people were also better at judging fluctuations in their weight compared to older Americans.

The study's authors pointed out that not all participants thought they lost weight. They added that certain groups were more likely to report unintentional weight gain, including people under 40 years of age, smokers, minorities, and people with sedentary lifestyles and/or less-than-ideal diets.

Besides Diabetes and CVD, Obese Children Will Have 50% Higher Risk of Colon Cancer

The newest reason for doing everything possible to reduce childhood obesity names certain cancers as risks associated with a high BMI....



Obesity in childhood has a direct link with bladder and urinary tract (urothelial), and colorectal cancers in adulthood, warn Israeli researchers.

Childhood obesity is associated with all sorts of immediate health problems, including high blood pressure, high cholesterol, breathing and joint problems, along with an increased risk of developing diabetes and heart disease. This study set out to examine the relationship between childhood obesity and future diagnoses of urothelial, or bladder, and colorectal cancers.

Researchers at Tel Aviv University gathered the health information of 1.1 million males collected by the Israeli Defense Forces and then linked this medical data to the National Cancer Registry. They looked specifically at the rates of urothelial and colorectal cancer over a follow-up period of 18 years in those who were obese, meaning that they had a body mass index (BMI) in the 85thpercentile and above, at age 17. Adjustments were made for year of birth, level of education, and religiosity.

Those whose BMI placed them in the range of obesity in adolescence had a 1.42% greater chance of developing urothelial or colorectal cancers in adulthood.

While these results only tell us about the incidences of two specific types of cancer, Ari Shamiss, one of the doctors involved in the study, has indicated that he is currently researching connections between childhood obesity and other cancers in the hopes of uncovering other connections. "We still need to learn whether obesity is directly causing the high risk of cancer, and, perhaps most essentially, whether losing weight is effective -- and if so, how much and when -- in lowering it.

In conclusion, childhood obesity is associated with a 50% higher risk of urothelial or colorectal cancers.

"Overweight in Adolescence is Related to Increased Risk of Future Urothelial Cancer," published in the journal Obesity.

Robert Downey Jr., Halle Berry, Kristen Stewart All Have Foot Injuries

Ankle Injury

Production on "Iron Man 3" has been suspended after leading man Robert Downey Jr. injured his ankle while performing a stunt. "There will be a short delay in the production schedule while he recuperates," Marvel Studios said Wednesday in a statement regarding the incident which happened on the film's Wilmington, North Carolina, set.

With a budget said to be in the $200-million range, every day Downy Jr. is not working is major money down the drain. The silver lining: It's a Marvel production! With the success of "The Avengers," which has made nearly $1.5 BILLION worldwide, they can afford it. On set injuries are nothing new to Hollywood.



Hurt Head and Foot

Halle Berry reportedly suffered a minor head injury this summer while she was shooting a fight sequence for her upcoming film "The Hive." Her rep said she was taken to the hospital "as a precaution." Apparently Berry is a bit accident prone: She suffered a broken foot last year at her rented villa on a day off from production of the upcoming "Cloud Atlas."



Hand then Foot

Production in London came to a halt on "Snow White and the Huntsman" when Kristen Stewart injured her hand last year. Stewart also reportedly suffered a puncture wound to her foot during reshoots of the upcoming "Twilight Saga: Breaking Dawn: Part 2."

Pointers For Protecting Feet From Skin Cancer

(ARA) - Walking on the beach, frolicking in the surf, participating in sports, strolling through a theme park while on vacation - your feet will carry you through a lot of fun this summer. But can paying attention to them help you avoid the most common form of cancer in America? Possibly, experts say. Each year, more than 1 million Americans are diagnosed with skin cancer, according to the National Cancer Institute (NCI). Yet only 32 percent of Americans use sunscreen to protect themselves from the sun's damaging rays, NCI says in its Cancer Trends Progress Report. Even when sunscreen is applied, the feet are often neglected.

"While skin cancers typically appear on areas of sun-exposed skin like the face, arms and hands, they can also occur on areas that get much less sun, such as the feet," says Dr. Joseph Caporusso, a podiatrist and president of the American Podiatric Medical Association (APMA).

"With flip-flops and sandals being common summer foot attire, more Americans than ever are exposing their feet to the sun's potential harmful rays." Sun exposure, however, isn't the whole story when it comes to skin cancers on the feet. More often, skin cancers of the feet can be linked to exposure to viruses or chemicals, chronic inflammation or irritation, or even inherited traits, according to APMA.

"Unfortunately, the skin on our feet is often overlooked during routine medical checkups," Caporusso notes. "Yet, foot health can be an indicator of overall health. It's important for everyone to have their feet checked regularly by podiatrist for any signs or symptoms of skin cancer."

APMA offers a few tips for protecting your feet this summer:
* Apply the same broad-spectrum sunscreen you use on the rest of your body to your feet, including the tops, on and between the toes, and even the soles of your feet. Reapply every two hours when you're out in the sun and more frequently if you spend a lot of time in and out of the water.

* Conduct regular self exams of your feet. Look for signs of problems, such as cracking or sores. Keep in mind that freckles and moles on the soles of the feet are very unusual, and may be a sign you should see a podiatrist.

* Be aware of the warning signs for malignant melanoma - the most deadly type of skin cancer. This type of cancer may occur on the skin of the feet and on occasion, beneath a toenail. Learn the ABCDEs of melanoma: Asymmetrical lesions, Border irregularity, Color variation, Diameter larger than a pencil eraser, and Evolving characteristics of any of the ABCD traits. If you notice a mole, freckle or lesion with any of these characteristics, have your health care provider take a look.

* Skin cancer of the feet can easily be mistaken for other, less serious problems. For example squamous cell carcinomas, the second-most-common type of skin cancer, may resemble a plantar wart, fungal infection, eczema, an ulcer or other common dermatological condition.

* Skin cancers in the lower legs, ankles and feet may look very different from those that occur in the rest of the body. Podiatrists are uniquely qualified among medical professionals to treat lower extremities, so their knowledge and training can help patients detect both benign and malignant skin tumors early.

Bunions Painful?

Prolonged changes to normal foot patterns can lead to the formation of bony protrusions commonly known as bunions.

Typically caused by tight fitting footwear, a bunion can be an eyesore, although the real sore is experienced on the great toe and sometimes the fifth toe (Tailor's Bunion). For early stages, preventing the bunion from enlargement is important.

Prevention can be achieved with orthotics that relieves pressure on the bunion.
Orthotics may be semi-rigid to rigid to meet the accommodations each person needs who are suffering from bunions. Orthotics are devices worn in your shoes that provide correction to your feet, helping them to function more efficiently.

Prescription orthotics may help relieve your pain by realigning and stabilizing the bones in your feet, restoring your natural walking pattern. They will also help alleviate pain from rubbing, which often leads to enlargement of the protrusion.

Patients should be advised to wear comfortable shoes that help support their feet. Taking preventative measures in the initial stages of the bunion’s existence is a great way to slow its growth.

Be sure to come by and see Dr. Weaver about getting your custom orthotics today and stop the unsightly growth of your bunion. The key to better health could be right under your toes.

Pedicures and Painful Nails

While having a pedicure at the local nail salon may seem like a luxury that you deserve, it’s a good idea to keep your eyes and ears open and to make sure that you keep your feet safe by following a few easy tips.

If you schedule your pedicure first thing in the morning, you may find that the foot bath is the cleanest it will be all day. If you can’t be the first customer, however, make sure that the technician cleans both the tub and the filter prior to your pedicure.

If at all possible, bring your own pedicure tools to the salon. Bacteria and fungus can easily be transferred from person to person on these tools, especially if the salon does not use proper sterilization techniques. Never allow technicians to use blades or knives to cut your calluses or to eliminate thick, dead skin. Only use pumice stones, foot files or exfoliating scrub. Once you soak your feet for a few minutes, this thickened skin can be easily sloughed off with these types of tools.

The pedicurist should trim your nails straight across. Do not let them dig into the sides of the nails or try to trim out ingrown nails. If you think you may have an ingrown toenail, see a podiatrist immediately.

Only healthy nails should be painted with colored polish. Make sure to change the polish frequently and to check your nails when the polish is off. Signs of fungus and other nail problems can often be hidden under nail polish, so be vigilant in checking your nails.

If your skin bleeds or gets nicked at the salon, make sure to carefully clean and disinfect that area and then watch for signs of infection. Call Dr. Weaver immediately if you have any signs of redness or skin irritation after your salon visit.

Missy Franklin says her huge feet are a big topic in London

Missy Franklin is getting lots of attention in London and it has nothing to do with her historic medal haul at the Aquatics Centre. Well, it has something to do with it.

The 17-year-old rising high school senior told NBC on Monday that her size 13 feet have been drawing attention from athletes around the Olympics. Host Michele Beadle joked that she'd put a stop to those having fun at the expense of Missy's trotters, but Missy, in her typical bubbly demeanor, said she doesn't mind. In fact, she's proud of her big feet.

And why wouldn't she be? Those feet helped her win four gold medals in London and played a part in her becoming America's Olympic sweetheart. Her dad says they're Missy's "built-in flippers."

Sometimes you see young female athletes with abnormal size become uncomfortable in their bodies. Missy has none of that. Given how gracefully she moves in and out of the pool with her 6-foot-1 frame (remember that "Call Me Maybe" clip?), it's no wonder.

"I think it's helped me so much," she told ThePostGame last year. "God has blessed me with an excellent swimmer's body."